Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 10
This report estimates subtotals of units and fees for the number of days of overlap between each included
FSPSA record and the user-selected report period. For example, if the FSPSA record authorizes services from
01/01/01 to 08/01/01, and the Report Period is selected as 01/01/01 to 03/01/01, this summary calculates
authorized units/fees for the 28 days of overlap (02/01/01 to 03/01/01). Note that service authorization periods
may range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs overlapping: 10-01-15 and 12-31-15 Date of Report: 02-12-16 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2741 FSPSA's found of which 1049 had no frequency modifier field, FORCE FREQ MODIFIER to 0
Services Cpt Code Number of Number of Total Units Total Fees Avg Fee
Children Records Overlapping Overlapping Per Unit Auth
Report Period Report Period
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 50 50 24.194443 $361.2200 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 54 55 23.922221 $459.3000 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 50 51 24.705554 $257.4300 $10.4200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 49 50 24.188888 $211.6500 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.205556 $1.6600 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 50 50 24.194443 $528.4000 $21.8400
AUDE -92585 AUD EVOKED RESPONSE (COMP) 27 27 13.033332 $848.9800 $65.1400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 48 48 23.172221 $530.6400 $22.9000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 2 2 1.677778 $85.6500 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 1.022222 $52.1800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 5 4.300001 $219.5200 $51.0500
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Subtotal (Total Children Is Unduplicated) 80 340 164.616659 $3556.6500 $21.6100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.511111 $2555.5000 $4999.8900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 26 39 28.351187 $1417.5500 $50.0000
CONIF -CONIF CONSULT, FACE TO FACE 234 480 443.811107 $22190.5300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 62 83 768.842061 $38442.1400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 857 1692 1331.642554 $13316.3800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 19 21 195.285715 $13951.2200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 37 43 237.507938 $16967.5900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 39 42 300.138098 $21441.8400 $71.4400
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Subtotal (Total Children Is Unduplicated) 992 2401 3306.089771 $130282.7600 $39.4100
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Total 2741 3470.706430 $133839.4100 $38.5600
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Number of Children (Unduplicated) With at Least One Authorization 1001